Individual provider Active NPI

Clair Marcus Morud

  • Internal Medicine Physician
  • Ashland, WI
National Provider Identifier
1174699268
Registry record updated May 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
29218-020 Issued in WI
Practice address
1615 Maple LN Ste 1
Ashland, WI 54806-3610
Phone
(715) 685-7500
NPI assigned
Nov 28, 2006
Last updated
May 23, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 29218-020 WI Primary

Addresses

Primary practice location

1615 Maple LN Ste 1
Ashland, WI 54806-3610

Mailing address

1615 Maple LN Ste 1
Ashland, WI 54806-3610
Phone (715) 685-7500

Other identifiers 1

IdentifierTypeStateIssuer
31410100MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
29218-020WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bad River Band of Lake Superior Tribe of Chippewa Indains Wis CurrentSince Mar 5, 2018 Accepting new patients
Bad River Band of Lake Superior Tribe of Chippewa Indians Wis Current Accepting new patients
Bad River Band of Lake Superior Tribe of Chippewa Indians Wis. CurrentSince Mar 5, 2018 Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

53585 Nokomis Rd
Ashland, WI 54806
Phone (715) 682-7133

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463961600000",
    "number": "1174699268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 MAPLE LN STE 1",
            "city": "ASHLAND",
            "state": "WI",
            "postal_code": "548063610",
            "telephone_number": "715-685-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 MAPLE LN STE 1",
            "city": "ASHLAND",
            "state": "WI",
            "postal_code": "548063610",
            "telephone_number": "715-685-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORUD",
        "first_name": "CLAIR",
        "middle_name": "MARCUS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2016-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "29218-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31410100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashland, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.